BEFORE THE COMMISSIONER UNDER __________ ACT, CIRCLE – __________

 _______________ Vs. ___________

CLAIM PETITION UNDER __________ ACT

RESPECTFULLY SHOWETH:

1-    That the above noted application of compensation was allowed by this Hon’ble court vide order dated ____________in favour of the applicant and against the respondents

2-    That the respondent No.3 ________________________ Limited has been deposited the amount of award amount to the tune of Rs. ___________/-on _____________which is lying with this Hon’ble court.

3-    That the applicant wants to withdraw the above said award amount from this Hon’ble court.
It is, therefore, prayed that amount of award may kindly be released in favour of the applicants.

Dated: __________

Applicant

THROUGH COUNSEL:___________, Advocate, _____________